Vote, Argue, Vote Again: Peer Instruction for Anticoagulant Pharmacology in a 64-Seat Associate Degree Lecture, With the Evidence, Three Concept Questions and a Test of Whether It Worked
Student Name
American College of Education
NUR6023: Transformational Teaching in Nursing Education
Module 1 Assignment
Instructor Name
May 6, 2030
The Teaching Problem
I teach Pharmacology for Nursing in a composite community college's associate degree program. The course meets for three hours a week in a 64-seat lecture room, and anticoagulants are one of its hardest weeks. Students must distinguish heparin, low-molecular-weight heparin, warfarin and the direct oral anticoagulants by mechanism, monitoring and reversal, and must apply that knowledge to decisions such as whether to give a dose when a laboratory value is abnormal. For three years I taught the week as a lecture with slides. Students took good notes, and on the unit examination they answered recall questions well, but they missed application questions at high rates. On last year's examination, 81% of students correctly identified the laboratory test used to monitor warfarin, but only 46% chose the right action for a patient on unfractionated heparin whose activated partial thromboplastin time was above the therapeutic range. My lecture was transmitting facts but not building the reasoning the questions required.
What the Evidence Says About Active Learning
The case against relying on lecture is now strong. A meta-analysis of 225 studies in undergraduate science, technology, engineering and mathematics courses compared traditional lecturing with active learning and found that examination and concept inventory scores were 0.47 standard deviations higher under active learning, equivalent to an average improvement of about six percent, and that failure was one and a half times as common where lecturing was the norm (Freeman et al., 2014). The studies were not in nursing, but pharmacology is a science course taught to large groups, which makes the comparison reasonable. Evidence in nursing points the same way. Pooling nine nursing publications, one integrative review reported that scores on the licensure examination and on standardized predictor examinations were higher when active learning methods were used than in classrooms using more traditional methods (Shatto et al., 2019). The evidence does not say that any activity helps; it says that students who do something with the content during class learn it better than students who only listen.
Why Peer Instruction
Among active learning strategies, I chose Peer Instruction, developed for introductory physics at Harvard. Crouch and Mazur (2001), reporting ten years of experience with the method, describe a class built around short conceptual questions: the instructor presents a question, students think and commit to an answer individually, then discuss their answers with neighbors and try to convince one another, and then answer again, after which the instructor explains. Over those years, students in Peer Instruction courses showed gains in conceptual understanding and in quantitative problem-solving.
Three features make the method fit my situation. It works in a fixed-seat lecture room with 64 students, where group work that requires moving furniture is not possible. It targets exactly my problem, misconceptions that survive a lecture, because a student who holds a wrong idea must commit to it and then defend it to a neighbor who may hold the right one. And it gives me information in real time: the distribution of votes shows which ideas the class has and has not understood, while there is still time to address them. A lecture tells me what I said; a vote tells me what they heard.
Alternatives I Set Aside
Peer Instruction was not the only option, and two others deserved a hearing. Unfolding case studies are popular in nursing pharmacology and closely resemble the licensure examination's case-based items. But a case study worked in small groups needs more time and space than my room allows, and in a class of 64 the instructor hears from only a few groups, so misconceptions held quietly by the rest can survive the session. I will use one short case at the end of the class to pull the concepts together, but not as the main method. Team-based learning, which I will examine in the next module, offers stronger accountability through individual and team readiness tests, but it requires permanent teams and a course-wide structure that I cannot introduce halfway through a semester. Peer Instruction can be adopted for a single week, tested and then extended, which suits a first attempt at changing my teaching. It also has a practical advantage for me as the instructor: it asks me to rewrite my slides as questions rather than build a new course, which makes it possible within the preparation time I actually have.
Three Concept Questions
Each question is written to expose one misconception I have seen on examinations. Question one: a patient receiving a continuous heparin infusion has an activated partial thromboplastin time well above the therapeutic range and no signs of bleeding; what should the nurse do first? The options include giving vitamin K, stopping the infusion and notifying the provider, continuing and rechecking in six hours, and giving protamine. The misconception is confusing the reversal agents for heparin and warfarin. Question two: a patient on warfarin has a therapeutic INR and asks why he still needs his enoxaparin injections that started two days ago; which answer is correct? The misconception is not understanding that warfarin takes days to reach full effect and that the overlap is intentional. Question three: which patient's anticoagulant is least suited to being monitored with routine coagulation tests? The misconception is assuming that every anticoagulant is monitored the same way, when the direct oral anticoagulants are usually given without routine monitoring.
For each question I use a simple rule. If fewer than a third of students answer correctly on the first vote, the concept has not landed, and I reteach it briefly before a second, similar question. If between a third and about two thirds are correct, I ask students to discuss with a neighbor who chose differently and vote again. If more than two thirds are correct, I explain briefly and move on. The three-hour class will include eight to ten such questions, with short explanations between them, replacing most of the slides.
Preparation, Technology and Resistance
Peer Instruction shifts some content delivery out of class, so students need a preparation task. Before the anticoagulant class, students will read the assigned chapter and complete a short online quiz of five recall questions, which frees class time for application. Voting will use the college's free audience response system on students' phones, with printed cards as a backup, since several students have older phones and the room's wireless signal is unreliable. I also expect some resistance. Students who are used to lectures may feel that discussion is a waste of time or that the instructor is not teaching. I will explain the method in the first class, show the evidence briefly and point out that the application questions they will face on the licensure examination are exactly what the discussions practice.
How I Will Know It Worked
The evaluation compares this year's cohort with last year's on the same examination items. The unit examination will keep the six anticoagulant application items used last year, and I will compare the proportion of students answering each correctly, with the heparin item as the primary measure. I will also compare first-vote and second-vote accuracy on each concept question, since rising accuracy after discussion is the method's mechanism. Cohorts differ, so a single year's comparison is suggestive rather than conclusive, and I will repeat it next year. If the application items improve and recall items hold steady, I will extend Peer Instruction to the cardiac and antimicrobial weeks.
References
Crouch, C. H., & Mazur, E. (2001). Peer Instruction: Ten years of experience and results. American Journal of Physics, 69(9), 970-977. https://doi.org/10.1119/1.1374249
Freeman, S., Eddy, S. L., McDonough, M., Smith, M. K., Okoroafor, N., Jordt, H., & Wenderoth, M. P. (2014). Active learning increases student performance in science, engineering, and mathematics. Proceedings of the National Academy of Sciences, 111(23), 8410-8415. https://doi.org/10.1073/pnas.1319030111
Shatto, B., Shagavah, A., Krieger, M., Lutz, L., Duncan, C. E., & Wagner, E. K. (2019). Active learning outcomes on NCLEX-RN or standardized predictor examinations: An integrative review. Journal of Nursing Education, 58(1), 42-46. https://doi.org/10.3928/01484834-20190103-07
How this NUR 6023 Module 1 example is structured
NUR 6023 Module 1 typically analyzes an evidence-based active learning strategy for a nursing topic; your classroom's instructions decide the strategy and topic. This example states the teaching problem, reviews the general and specific evidence, explains the strategy's mechanism, justifies its fit to the content and learners, shows the strategy applied with real materials and ends with an evaluation plan.
NUR6023 Module 1 questions, answered
What does NUR6023 Module 1 usually ask for?
NUR6023 Module 1 typically asks you to analyze an evidence-based active learning strategy and apply it to a nursing topic you teach or might teach. Your classroom's instructions decide the strategy and topic.
What is Peer Instruction?
A method in which students answer a conceptual question individually, discuss their answers with peers, and answer again before the instructor explains. It was developed for large physics classes and works well in fixed-seat rooms.
How do I show the strategy worked?
Compare performance on the same application items before and after the change, and track whether answers improve between the first and second votes, which shows the method's mechanism at work.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.